June 10, 2008

Detox


I hesitated as to whether I would write this and then keep you posted on my progress, but why not? It's a bit of a change-up and might help me keep my sanity in the next weeks.

For six months I've been on Cymbalta, starting in the week before Christmas. Good thing, because I was a mess, crying daily in the car and just altogther ready to pack it in. Everything was just an overwhelming burden. I couldn't find the energy of even desire to prepare for Christmas. We agreed to have family over and it seemed like a monumental effort and a week before I hadn't even started preparing. Gifts hadn't been bought for even my immediate family. You get the picture. My psyche was in a pit a million feet deep and I saw no way out. I spent more time crying than just about anything else. Finally, I reached out to my doctor of ten years. She tried to hide her shock at my appearance which by then looked exceedingly tired and desperate. Some people sleep through depression, I stay up, then suffer later from the lack of sleep. Viscious cyle.

I was prescribed a low (30mg) dose to get my body used to it, but in a week I went up to the therapeutic dose (60mg) and have been on them for the past six months. It did its job, but its power has begun to fade and my body has been rebelling physically to the daily regimen.

It's time to wean myself. The stress of the primary election is over, and another loss (menses) means I need to be clear thinking on how to proceed with THAT. And although the drug got rid of my really really low lows, it also got rid of my delicious highs. I want them back. No...I've not been diagnosed bipolar, just clinical depression (runs in the family). Cymbalta stabilizes mood, I am told. I'm ready to shake off being a flatliner with a dip or rise here and there and get back to feeling, really feeling.

So...tomorrow begins my first day cutting back to a daily 30mg capsule, which will begin a three week taper, followed by another 3 weeks of taking a pill every other day. Things may go smooth, or they may go rough. As I understand it, this is one of the hardest drugs to quit.

We know what could be, but we don't know what my withdrawal will be like, but as always Sweetie is in my corner, and is my rock.

6-11-08: Edited in the cold light of morning to correct ridiculous typos.

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13 comments:

The Red Queen said...

I took effexor for exactly one week last fall.

It took me nearly a month and all my sanity to get off it.

If you feel like you're loosing your mind, I'm just an email away.

carissa said...

Thanks. I'm hoping this "tapering" regimen she's got me doing is going to work, but as of today I am officially below the "therapeutic" dosage and should know shortly what my journey off this stuff will do.

texex said...

Cymbalta is one of the greatest psychotheraputic breakthoughs of our time. And needing it is nothing to be ashamed of.

I've been on it and a combination of others for over two years now after going through everything made with the psychopharmacologist at UNR. I even went so far as to have a vagus nerve stimualator (ie., "pacemaker for the brain")implanted in a clinical trials at Baylor University in Houston.

So I understand your problem better than most as I live with it on a daily (sometimes hourly) basis.

I don't think it is addictive but if you can get along without it then put it in the med cabinet for reserves when you do need it. There's absolutely no reason to go through what you went through in Dec when modern medicine can prevent it.

And please remember that having depression is no different than having diabetes. It just means your body is not producing the right chemicals for a correct balance and it needs some assitance to keep things where they ought to be.

Mike said...

Texex:
"I don't think it is addictive but if you can get along without it then put it in the med cabinet for reserves when you do need it. There's absolutely no reason to go through what you went through in Dec when modern medicine can prevent it."
Me: I think her doctor (it sounds like) wants her to taper off. This is a new med to me. (I retired as a psych nurse in 1998.)
So, I don't know anything about it.
But, don't these types of meds require a therapeutic level to be established, over time? I'm not
so sure "prn" usage, one pill now and then when needed for feeling down, is the way to go. (But, again, I don't know about this med.)

Texex:
"And please remember that having depression is no different than having diabetes. It just means your body is not producing the right chemicals for a correct balance and it needs some assitance to keep things where they ought to be."

Me: Absolutely right. The medical model was ascendant when I left the field. And, that's because etiology for things like depression clearly have a biochemical foundation (mostly).

carissa said...

Right, one cannot just pop a pill every now and then and get the same benefit. It has to stay in the system for awhile. It's not a tranquilizer. Once on the meds it takes a while for the benefit to kick in.

Cathylee said...

Sending strength and positivity, dear friend.

carissa said...

Thanks!

texex said...

Mike (and others) depression and its alterego mania are products of three separate factors: 1) enviroment (home, work, etc.), 2) biochemistry (serotonin, norepenephrin, etc. from our neurosensors), and 3) biogenetics (heredity). So when a troubled time comes on it can come from any of these three factors or from an infinitely variable combination of them. In the latter case, as the factors change so do the effectiveness of the medications necessitating continual adaptations.

But medications alone are not a cureall if the problem persists. Psychotherapy should also be in the curative admixture with cognitive therapy showing amazing results. Some of the best 'cognitive therapy' is self-administered when a person is able to evaluate any environmental influences which may be negatively affecting their lives (e.g. plaacing tooo much importance on extranneous things such as political campaigns which we have no control whatsoever over).

carissa said...

I don't have mania...unless it's in a very, very mild form, but it is true that I have to work at being able to sort what is necessary, what is helpful, and what is not. I'm reasonably good at it, if left to decide on my terms and therein lies the rub.

The problem with being as engaged as I have been over the past years is that what began as a passion eventually becomes a burden that is loved and loathed at the same time.

texex said...

No - I wasn't suggesting you were manic at all and apologize if it sounded that way. It's often harder to detect than depression and it's very much harder to treat effectively. It's also possible to have excessive depression and mania at the same time.

If you're already doing some cognitive therapy on your own (i.e., trying to analyze why you feel the way you do taking into consideration outside negative influences that are making you "down" and/or irritable) you are well on the road to stability and recovery. Read up on cognitive therapy and I think you will find it a very useful tool to have in your life. And keep prioritizing what makes your and "Sweetie's" life most happy. If extranneous junk (e.g. politics) is interfering with that ultimate happiness then dump it and devote those energies to you and him.

Mike said...

That's a great summary (of causes and approaches), texex.

I would just add on to what you directed us to, cognitive therapy, and also mention the "therapy" that is reportedly a major breakthrough. (In fact, I know it's the primary therapy used at a nearby major city VEteran Hosp.)
Called "Acceptance and Committment Therapy", it's laid out in detail in a workbook called "Out of your mind and into your life." Steven Hayes from UNR. Time Magazine did a great story on this a couple of years back.

Carissa:
"The problem with being as engaged as I have been over the past years is that what began as a passion eventually becomes a burden that is loved and loathed at the same time."

Me:
I think this is true of many of us.

texex said...

Yes, but the triad of environment- biochemistry-heredity is still the holy grail for effective treatment. You cannot treat just one part of the triad (e.g. biochemistry with medicine or environment with cognitive therapy) and realistically expect lasting results.

Heredity is too big of a factor to ignore in this disease as it is with diabetes or heart problems or any other inherited disposition. However, the (unwarranted) social stigmas of the past have led many people to mask their problem from their descendents. It's usually up to the person in the present to try to uncover this medical history and that's not always an easy or comfortable thing to do.

At the risk of repetition, one must treat the whole triad - not just one leg of it.

carissa said...

Agree especially about the heredity thing. On my mother's side of the family it is pronounced...my grandfather, my mother (though I am sure she'll never admit it), me, my daughter. There's something misfiring in all of us, and that any coping mechanism that can be brought to bear is a wonderful thing.